Are work being unreasonable?? And when to start mat leave - working as a doctor

(51 Posts)
jellyspoons Fri 24-May-13 12:46:36

Hi,
This is my first post so hope it goes OK!

I work as a hospital doctor and am pregnant with my first baby, due in September. I work shifts, and so far work have said they have no obligation to reduce my hours at any stage in the pregnancy whatsoever (including nights/13 hour day shifts/carrying the crash bleep), though if I get to the stage where I really can't cope then they would have a rethink and sort something at that time. We're short staffed as it is so I can see why the consultants are reluctant to take me off the oncall rota.

My current job finishes on Sept 3rd (I'd be 37+6), and my last two shifts are night shifts. The week before I have very tiring oncall shifts Mon-Thurs. If I finished the preceding Friday to that, I'd be 36+2.

Work have asked me to swap my night shifts and oncalls from later in the pregnancy to earlier in my pregnancy as a "goodwill gesture", especially the night shifts in early September at 37+ weeks as these will be difficult for them to cover as they encompass the change of job period. There are other night shifts at 33 weeks and 28 weeks I'm also due to do.

Currently I've been remarkably well during my pregnancy (hope it continues!). I wonder if I'll get bored if I go off work too soon, but, I also don't want to push myself more than I can manage. Work implied that if I swap the night shifts in early September at 37+ weeks then they might be more amenable to sorting out cover for other shifts earlier in the pregnancy - though I'm not sure whether to believe them! I'm planning on taking 9 months mat leave but may want to extend it to a year, I'm not sure yet. So I don't want to go off too early and sit around bored pre baby, then be forced to go back before I'm ready to at the end of mat leave. I also reckon I'll be over my due date as my mum was late with all 3 of us by 2 weeks!

So! I think I should probably go on mat leave at 36+2 and leave them the issue of sorting cover for the subsequent shifts, but I also am unsure as how much I should pander to the consultants putting pressure on me to swap shifts, in order to get goodwill from them. I also don't know whether if I just carried on, then saw my GP and got certified as "too tired to do oncalls" then they'd be forced into being reasonable and I could work 9 - 5 or equivalent for the last few weeks before going off at 37+2 - this would be my preferred option if possible, I think, but it seems a bit risky rely on (especially as the oncall shifts, whilst knackering, are 9 hours and so they could probably make me do them I guess).

Thoughts??? Anyone else been in a similar situation?
Thank you!!

ApuskiMcClusky Fri 24-May-13 12:49:56

Hello, welcome!

Have work completed a risk assessment with you?

jellyspoons Fri 24-May-13 12:50:47

Kind of - there was a sit down chat but nothing put down in writing...

jasmine31 Fri 24-May-13 13:01:27

Hello!
I don't know where you stand legally but working 13hr shifts and night shifts doesn't seem like a good idea later in pregnancy. You will know better than me but I thought there was a link between night shifts/long hours and prematurity/low birth weight.

I had my baby in Sept last year and got signed off night shifts (as a vet) at around 6 months. I didn't want to wait until I was physically struggling and getting stressed out. Most of my colleagues who became pregnant did the same, many of them earlier in pregnancy.

What do other hospital doctors do in your situation?

Good luck with getting something sorted.

Fishlegs Fri 24-May-13 13:01:39

I think the consultants are being unreasonable, but you can go via Occupational Health, who will do the risk assessment and make recommendations.

Are you doing gen med? It seems crazy to be giving you the crash bleep cos you ain't gonna be able to run anywhere soon!

I work in EM and although there's the odd person who's happy to work a full rota till 38 weeks, most people stop doing nights by the time they are 27 weeks or so. With my first baby I did my last lot of nights at 27 weeks and it was fine. Everyone was kind and made allowances, giving me plenty of drinks and a seat at every opportunity.

I'd also stop at 36+2, you don't want to be doing that last week of on call. Sure it'll be a bit of a headache for them to cover it, but your priority is the health and well-being of you and your baby and that has to come first. Most reasonable consultants would think like that so don't be put off if this bunch are unsupportive.

BikeRunSki Fri 24-May-13 13:09:10

I am not medical in any way, but I do a professional job with a night duty rota, which I stopped at 28 weeks. I went on mat leave at 36+5 in both pg, quite happily and really quite ready to finish. As for your baby being late - I wouldn't rely on it. My mum had 2, one early, one late: mine have both been early, my sister 's both late.

Kendodd Fri 24-May-13 13:12:19

Congratulations on the baby and good luck with the next bit.

My current job finishes on Sept 3rd does this mean you won't be working with the same people when you come back? Or you'll get a new job entirely or it's just when ML starts?

If you will be leaving I think this gives you a lot more leeway to make demands (even though these 'demands' may be things you're legally entitled to) in the real world, you might have to still work with these people and need to keep them sweet.

I think you need to have a pregnancy risk assessment done, which I believe is a legal requirement. Get that done/redone and take in from there.

As for going on leave early, make the most of it, sleep late, go to the cinema, go shopping, it may be YEARS before you get to do these thing again.

jellyspoons Fri 24-May-13 13:36:34

Fishlegs - Yeh I agree it does seem unreasonable to me. It's funny, when I had the conversation with the consultant she somehow made it seem quite reasonable and sensible to "see how I go", but in retrospect it now seems a bit miserable! Two consultants have suggested there's no need to see occupational health unless I felt unwell, but I think you're right occy health are probably more likely to be sensible about it.

I work in paeds, and the crash bleep covers paeds and neonates. (The neonatal one goes off quite regularly).

Jasmine - yeh I've been looking up the stuff on prematurity from shift work etc but the latest evidence seems to show a small / non existent risk www.ncbi.nlm.nih.gov/pubmed/23343859) so not sure I can use that to help me.

Other doctors - well, I have friends who worked the same job as I'm doing, last year, and work were also very inflexible and said the same things and they were forced to do full shifts until 36 weeks (or take sick leave if they weren't coping) then go off on maternity leave at 36 weeks. However, in other hospitals friends working at my grade have been automatically told nights and shifts longer than 8 hours are banned after 28 weeks, and this has been put into place without them having to do anything at all. So I think it depends on the hospital and my one happens to be short staffed and therefore less flexible...

jellyspoons Fri 24-May-13 14:08:16

kendodd - my current rotation finishes on September 3rd, so if I wasn't pregnant I would then move from this job to a different hospital but still working within the same specialty and training programme. So I'd still have a job, but it would be working with different people. It's a standard part of being a hospital doctor to rotate jobs every 6 months or so.

Yeh I hear what you're all saying and I think it is the right thing to do, go off at 36+2, it does slightly annoy me that it doesn't seem possible to plan to work til 37/38 weeks but on 9 - 5 shifts, as this would be my preferred option. But from what my colleagues tell me who did the same job last year, not even occy health / a proper risk assessment would stop me from doing the 9 hour oncall shifts as these aren't considered excessively long hours.

Have just spoken to another friend and after occy health involvement she stopped doing nights after 30 weeks, and reduced 13 hour shifts to max 9 hours, thought still had to carry the crash bleep for her entire pregnancy.

I really don't like confrontation so I'm just kind of dreading speaking to the consultants and saying I'm not going to do what they've asked me to!

Thanks for the support, guys.

ApuskiMcClusky Fri 24-May-13 14:09:19

With the new 'fit note' system, it's easier for GPs to specify that you can continue to work but with accommodations made, and they can specify what those should be - e.g. no nightshifts or on-calls; if work then feel they can't meet those requirements, then you would be off sick as usual. So it isn't now a choice between being signed off sick or doing what they tell you, your GP can support you, so this is a good back-up position to have (worth talking to your GP about your possible concerns upfront so you can get a sense of their level of support).

But I agree that Occupational Health are the first stop - they will be geared to supporting you so that you can work as long as you can / want to rather than risk overdoing it and having to be signed off.

If the consultants fret about it, just say that you want to plan ahead - that you don't want to drop them in it at the last minute if you're not able to cope, and that having a plan in place will help you feel better able to manage your workload.

jellyspoons Fri 24-May-13 14:10:05

My friend also said that the department made her swap her long days and oncalls to earlier in pregnancy so she ended up with loads of them at 30 - 34 weeks, which made her so knackered she had a miserable time and went off sick for a bit then off on mat leave as soon as she could at 36 weeks. Miserable!

jellyspoons Fri 24-May-13 14:14:24

Apuski - Yeh the "planning ahead being the best thing to do" I totally agree with, but the consultant I did the verbal risk assessment specifically said this that planning ahead was not departmental policy as they preferred to see how it goes. So they aren't very receptive to this argument.

One of the problems is that over 50% of the rota is one kind of on call or another, and even standard day shifts that I do the minority of the time, I carry the neonatal crash bleep during those. So the whole thing is just a bit of a nightmare really.

Ah, neonatology. Of course.

I have some second hand experience of the training and I have to say that I think the consultants ABU. Do I understand correctly that they want you to do more long shifts now to make-up for the fact that you will be physically unable to do them later on in your pregnancy?

I think that is an outrageous idea. I know a lot of consultants used to work longer hours during their training, but that has changed for a reason. The rotas in most places are designed in a way that enables proper rest after intense periods of long shifts or on-calls. Especially in an intense and acute specialty like neonatology. As far as I understand, it is planned this way so that doctors (even those healthy ones who are not pregnant) have a chance to rest. How would it be fair on you to take on an excessive workload during a physically difficult time? I understand they are understaffed, but that is their responsibility to sort out. They should not pressurise you into taking on additional, tiring shifts now because you will be unable to do them later - you are having a baby, not jetting off on a nine-month holiday.

I think it is fine for you to carry on working for as long as you want, but I think it is unreasonable for them to want you to take a heavier workload now. Your shift pattern is actually very demanding as it is, there is little reason for you to have to strain yourself for the benefit of the consultants.

jellyspoons Fri 24-May-13 14:35:29

youngblowfish - Yep that's exactly what the consultants have asked me to do - swap the night shifts, on calls and long days to earlier in the pregnancy so that they are covered. They've specifically said that if I don't do this then my colleagues will be made to do them at the last minute with short notice which will be difficult for everyone. And speaking to my colleague who was in the same position last year she said they "made her" do these swaps which was one reason she had such a tough time from 30 weeks onwards.

Yeh it is ridiculous that working in neonates with prem babies every day the department don't have that in their mind as a reminder to actually be nice to pregnant women!! But it does seem to be the case.

So yes, the more I think about it the more it seems crazy to swap shifts to earlier in the pregnancy, it would be really hard work. (Plus from my reading of the law it doesn't seem they have the legal right to ask me to do this). However, it's easy to say this here on a web post but saying it to the consultants who are my bosses is a bit harder. Eek!

hedwig2001 Fri 24-May-13 14:50:13

I work in Neonates. We have 2 pregnant SHOs at the moment. Both are working reduced hours.
See occupational health. Also maybe discuss with your Obstetrician.

ApuskiMcClusky Fri 24-May-13 15:00:41

Planning ahead is inevitably hard, as people's pregnancy experience at work varies from able to carry on exactly as before to being signed off for the whole pregnancy with severe hyperemesis, for example, and anywhere in between. But their approach seems to assume everyone will fall into the first category, which really, with the job you have and how demanding it is, I would say is not typical. So it seems more sensible to plan for the 'average' pregnancy experience!

Hope Occ Health can give some good advice - and to me it sounds like you are trying to get a good balance between your conscientiousness and your wish to cope with your pregnancy.

Cookiepants Fri 24-May-13 15:10:44

Hi Jellyspoons,

I'm due September, and work shifts as a critical care nurse, so know what you mean. I'm nearly on permanent nights til I leave sad . As I understood it I would not be allowed to work past 36 weeks without a note from my GP / midwife and occy health which they do not like doing. People have advised me to 'see how I go' and not do anything I feel unhappy with i.e moving heavy patients or nursing aggressive ones! They are a little better at making sure I get breaks and leave on time though.

Oh, jelly, but surely that is blackmail? Please make a fuss. What they are proposing is so unfair, I am a little at a loss for what to suggest in terms of making them realise their appalling empathy by-pass.

Points I would make:

1. You are not responsible for organising the rota, they are. Telling you that your colleagues will be made to suffer if you do not increase your workload to dangerous levels is unfair and very possibly illegal. What about the European Working Time Directive? I am sure you can possibly phrase it in a slightly less confrontational manner, I am just angry on your behalf.

2. I do not see how they can make you swap your shifts. Suggesting this as a 'good will gesture' when they threaten to make your colleagues work extra for you is surely a contradiction in terms? I don't think they would have a leg to stand on legally, but hopefully it won't escalate. Certainly, all doctors I have ever come across only swapped shifts if it suited them or if they were getting a favour in return. If the person organising the rota cannot get adequate levels of cover, then they need to find a locum.

3. You can try phrasing it in terms of how you want to work for as long as possible, but working within the current rota as opposed to doing crazy swaps. Do use the example of your friend who has worked there before and had to go off sick due to being overworked - emphasise who you'd like to avoid that.

4. Is there a sensible consultant at work that you could speak to who could possibly back you on this issue?

In all honesty, what they are trying to do is put excessive strain on a pregnant woman for the sake of cost-saving. Do you think that is reasonable under any circumstances? I think they see you as a soft target. It disappoints me so much to read a story like this, when a woman who is clearly very intelligent, capable, and committed to her work is made to feel as if she is putting others out by being pregnant. What a sexist attitude.

jellyspoons Fri 24-May-13 18:01:36

Aw thanks, youngbf. It's really nice to hear what other reasonable people think so I know it's not just me making a fuss for no reason. And the way you phrase it makes a lot of sense.

Having said that, though, I've had my fingers burnt in the past on one occasion for drawing attention to myself (I put in writing my concerns about an incompetent senior colleague, who then made a counter complaint saying I was incompetent, which led to a whole headache) so I've become a little bit cynical as to fighting battles after that. I'm afraid whistleblowing in the NHS / fighting employment rights in my experience seems to become a massively stressful exercise even if you're in the right. Hence why I'm acting a little like a wet blanket currently!

Yeh, the EWTD applies unless you opt out of it, and if you organise your own swaps you automatically are opting out of the protection of it. So that wouldn't apply (though as I said, I do know they can't force me to do these swaps, as long as I stick to my guns and don't stress about the hassle for my colleagues).

The consultant that I had my verbal risk assessment thing with is probably the most approachable female one in the department, she's got kids and is part time herself. And she didn't say these comments in a threatening way, it came across as a very reasonable conversation in the way she said everything, somehow (don't quite know how!!). She's also one of 2 designated consultants in the department for this kind of issue, the other one is far stricter and I think would be far less likely to be sympathetic. Then there's two other male consultants who are my designated supervisors / mentors, one at my hospital and one at a separate site, but I don't really think that getting these people involved would help me politically, I think it would just create bad feeling.

So.... I think what I need to do is firstly, not agree to any swapping of shifts to earlier in the pregnancy. Then, to plan to go off on mat leave at 36+2, but before that see my GP (who is really lovely and sympathetic) at 25 weeks or so and get signed off night shifts / 13 hour shifts from 28 weeks or whatever is reasonable. It seems with the fit note system that they shouldn't really be able to argue with that. And I know enough GPs that if my current GP won't sign me off (which I doubt) that I'd be able to find someone who would. The sticking point will be that I'll still have to have the crash bleep for the whole time I'm working, but I can't do much about that. If I fight that one then (based on my colleague's experience last year) I think it would be a major incident and require my trade union etc to get involved - plus massively annoy the department, so probably not worth it.

I have no idea what any poor member of the public would think with me waddling along at 36 weeks with the crash bleep to a neonatal crash call... madness really.

thanks for the support again, it means a lot!

Sorry, RL got in the way.

Ha, I am sure they have a way of coming across as entirely reasonable, when they are, in fact, anything but.

Yes, I think your plan sounds perfect. Forgive me, I do come across as terribly forthright occasionally, but it was not my intention to suggest that you start a crusade against your unit's unfair practices. While it is true that I believe it would be best for patients and for the unit to decide sensibly how to manage busy, pregnant doctors, I think you are absolutely right in not rocking the boat too much.

I have little advice with regards to the bleep, but hopefully it will not be as big an issue if you do not work excessively long hours.

Anyway, best of luck with the negotiations (believe it or not, I also hate confrontation in RL) and best of luck with the pregnancy.

IJustWoreMyTrenchcoat Sat 25-May-13 10:35:52

Your NHS Trust should have a Pregnancy At Work policy as well as one on Maternity Leave and pay. It would be worth looking up in your HR policies so you know where you stand from a HR point of view.

I was looking at mine on the intranet at work just recently and it definitely had specific sections on night shifts, long hours and excessive standing etc. especially in later pregnancy. Ours also recommended pregnant members of staff should be taken off the Crash Team.

littleducks Sat 25-May-13 10:55:57

Being taken off the crash team seems sensible, i don't see how it could be fair on you or your patients for that to continue. I ran for the bus the other day and really overheated and felt ill afterwards. I don't think you could be expected to run, knowing a life may depend on it, then arrive and be in a fit state to do anything!

mamadoc Sun 26-May-13 09:05:26

Hi jelly spoons, I am a Dr and during my 1st pregnancy I worked until 37 weeks in gen medicine, shifts, nights, crash bleep. I really, really regret it.

My DD was born IUGR and spent 2 weeks in SCBU. I was healthy, non-smoker, normal BP, no RF and I truly believe the stress of my job was the cause. It was at the time of MMC. I was stressed out of my head with that thinking neither DH nor I would have a job. I went to a job interview on my due date! My consultants gave me the 'its not an illness, you can work as normal stuff'. I swopped my week of nights and did it at 30 weeks under pressure from them.

I now look back and think what was I thinking of! I don't know if this is true for you but I had trouble seeing my bump as a baby, a separate person I had to stick up for. I thought they were just doing this stuff to me so I should suck it up. Now I feel really differently. No job is more important than my kids.

DD was just fine in the end but the SCBU stay and subsequent focus on her weight really spoiled my first year with her and knocked my confidence as a mother.

For DC2 I was by now more senior and working in a more family friendly specialty. I did as per your plan above. Finished at 36 weeks, got signed off nights from 3rd trimester, didn't swop any shifts just worked them as rostered. Much, much calmer. DS born twice the size of DD in MLBU, bf easily established, home next day and I was so much happier. Contrast with the horrible hospital stay (in my own hospital with colleagues popping in whilst i was wired up to a double breast pump!) it was so worth it.

I haven't looked at the research lately but did at the time and I think some studies do show adverse effects of shift work, some don't. It did not make me feel reassured.

In summary: stay strong, do this for your baby, no job is worth as much as your child. These people putting pressure on you just want an easy life. They can organise cover they just don't want to bother or pay out. If they put it on your colleagues it is them causing the trouble not you. If you do make the sacrifice they will not remember or give you any credit and you are actually making it harder for others following to challenge this culture. It's going to feel a bit awkward but this is worth a bit of embarrassment. They cannot make you swop shifts or dictate when you take leave or go against a GP note so as long as you remain calm, polite but determined you will win out.

Dilidali Sun 26-May-13 09:27:33

It's an ongoing ' joke 'where I work about giving birth 3 hours after your last shift. It has happened in more than one occasion. Yes, the babies were small, needed a little hand in the first few days and the mums are adamant next time they won't leave it that late, and they don't.
I agree, see occy health, stop at 36 weeks. If you haven't got far to run from the dept to matty, keep the crash bleep, if it is miles, hand it over with a smile and go off sick, safer that waysmile.
Congratulations on your pregnancysmile.

jellyspoons Wed 19-Jun-13 02:29:49

An update on this...

I saw the occupational health nurse yesterday, who discussed with her consultant and emailed me back today. They've said from their point of view I have to go and see them again if I'm finding it too tough and they could make recommendations at that point to reduce hours / nights etc. But they wouldn't give out general recommendations in advance.

Oh I don't think I mentioned before on here, the latest line from the bosses (in addition to asking me if I've swapped my nights yet so I can still do them all), is that any shifts I get reduced in hours I have to "make up elsewhere". So if I go onto 9 hour day shifts instead of long day shifts, I have to come in on my days off to make up the shortfall of 4 hours for every reduced shift. Occupational health were totally useless about this and said that I'd have to discuss it with my line manager and be guided by what they said.

The crash bleep in the third trimester occy health said "could be risky" but they wouldn't specifically advise whether it was acceptable or not. Like I say, I'm a bit ambivalent about fighting carrying the crash bleep as I think if I fight it I'd end up doing paeds A+E shifts instead which although supposedly only 9 hours are completely shattering and tend to finish 1 - 2 hrs late with no chance to sit down or drink or eat all shift.

Oh and I also spoke to the BMA a while ago and they said everything work was saying was completely ridiculous and unreasonable and that if needed they could get involved. But I don't know that I want all that extra hassle!!

My GP said he'd write me a fit note saying whatever I liked on it, whenever (well he was a little reticent at first but then said he'd be happy to do whatever I wanted).

Hmm pretty frustrating and stressful all round really.
Mamadoc - thanks for your thoughtprovoking post. I had a bit of a panic the other day when I didn't feel movements for a long time (though pleased to report now getting kicked lots and lots!) and that made me think I should try harder to look after myself. Easier said than done. Got annoyed at myself yesterday for being persuaded to stay late by the consultant, I'm way too much of a push over and staying 2 hours late every day to sort stuff is not a good plan! And I won't be able to do it once I have a baby and nursery etc etc!!!

So yes, current plan (agreed with HR) is to finish for mat leave at 36+2. In terms of nights and long days, nothing is decided but I think I'm mainly tempted just to do all the rota'ed hours as it'll actually be less tiring than coming in on my days off (1 hr commute time also) to pay back the hours. And I'm too big a wuss to get the bma involved.

Right, best go to bed!
Argh have to sort whole of eportfolio by end of tomorrow to get year signed off! Not going to happen!!!!!! Especially when not allowed proper amounts of caffeine!
xx

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